jyotimittal
Forum Newbie
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Hi,
If a pt is diagnosed as ST elevation MI on EKG and we gave TPA and heparin. My question is how long (days) we have to give heparin and what are labs to be checked while the patient is on heparin? what is heparin nomogram? How do you interpret it?
Its a practical question, so may be people who are in residency can answer it ?
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| bill
Forum Newbie
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"When given with a thrombolytic, intravenous heparin is begun concurrently and given for 48 hours. Currently recommended doses include a 60 U/kg bolus (maximum 4000 U) followed initially with a 12 U/kg per hour infusion (maximum 1000 U/hour) with adjustment after 3 hours based on aPTT (target of 50 to 70 seconds, 1.5 to 2 times control)." - Cecil
Heparin wud warrant activated partial thromboplastin time (aPTT), rite?
Below is a heparin nomogram (wt-based) from Cecil
Weight-based nomogram for initial intravenous heparin therapy
aPTT :::::::::::DOSE(IU/KG)
Initial dose:::::80 bolus, then 18/hr
<35 sec:::::::::80 then 4/hr
35-45 sec:::::::40 then 2/hr
46-70 sec:::::::No change
71-90 sec:::::: Decrease infustion rate by 2/hr
>90 sec:::::::::Hold infusion 1 hr. then decrease rate by 3/hr
Edited by bill on 12/06/05 - 02:30 PM
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| jyotimittal
Forum Newbie
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thanks bill.
Looks like you have really good clinical experience.
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| sumie
Forum Elite
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do we really need to learn the nomogram
i am getting scared..
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sumie
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